Nashville Medical News July 2015

FOCUS TOPICS PERSONALIZED MEDICINE MEDICAL SCHOOL/CME

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PHYSICIAN SPOTLIGHT PAGE 2

James E.K. Hildreth, MD, PhD

ON ROUNDS

Professional Development: Programming Hones Clinical, Business & Leadership Skills Education plays a key role in the daily operations of both the Tennessee Medical Association (TMA) and Tennessee Nurses Association (TNA) as the statewide organizations strive to ensure providers deliver efficient, effective care of the highest quality ... 4

Implementing Innovation Update on Vanderbilt’s Curriculum 2.0

By CINDy SANDERS

Five years ago, the leadership of Vanderbilt University School of Medicine embarked on a quest to broadly restructure the undergraduate training program to better equip medical students with the knowledge and skills necessary to excel in real world practice. With the backdrop of a rapidly changing healthcare industry, the education leaders rethought, reworked and retooled the program.

The resulting Curriculum 2.0 represents a move away from traditional medical school education to a more collaborative, integrated, flexible course of study with enhanced case study and hands-on clinical experience. Aided by a grant from the American Medical Association’s Accelerating Change in Medical Education initiative, Vanderbilt’s Curriculum 2.0 made its debut with the entering class of 2013.

Bonnie Miller, MD, associate vice chancellor for Health Affairs and senior associate dean for Health Sciences Education, said at the foundation of the rebooted program is a commitment to creating master adaptive learners. “The most important thing we can do is teach our students to be expert, lifelong learners,” she said of the ability of these future providers to transform alongside the health delivery system.

Now approaching the halfway mark for the first class, Miller highlighted some of the changes implemented with the 2013 class.

(CONTINUED ON PAGE 6)

Breaking Through: Personalized Medicine Innovation Abounds in Nashville

By MELANIE KILGORE-HILL

Wang Debuts 3D Laser KAMRA in Tennessee

From academic powerhouses to high-tech startups, Nashville has become a recognized leader in personalized medicine. Nashville Medical News spoke to some of the industry’s leading experts to get a better glimpse into the treatment possibilities of tomorrow, and what that means for patients today.

Last month, Ming Wang, MD, PhD, performed the state’s first 3D Laser KAMRA procedure to improve near vision in certain patients with presbyopia ... 6

SCRI & the New Model of Medicine “In Nashville, we have one of the largest drug development units in the world,” said Todd Bauer, MD, associate director of Drug Development and principal investigator at Sarah Cannon Research Institute. “We really address every area of oncology through the clinical (CONTINUED ON PAGE 8)

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PhysicianSpotlight

Return Engagement

Meharry Welcomes Back Dr. James Hildreth as President & CEO Hildreth added he plans to have a front row seat for Meharry’s sesquicentennial. “Meharry will turn 150 years old in 2026, and I want to be around for that party … it will be quite a party,” he said with a laugh.

By CINDY SANDERS

Stepping into his role as 12th president and chief executive officer of Meharry Medical College on July 1, James E.K. Hildreth, MD, PhD, is entering new territory but on familiar ground.

After a yearlong process looking for the medical school’s next leader, the 11-member Meharry presidential committee, aided by global executive search firm Spencer Stuart, presented Hildreth to Meharry’s Board of Trustees as the right candidate for the job. Following a unanimous vote in early March to approve his appointment, the former Meharry faculty member and renowned researcher returns to Nashville to take the helm of the nation’s largest, private, independent historically black academic health sciences center.

In announcing the appointment this spring, Board Chairman Frank S. Royal, Sr., MD, noted, “Dr. Hildreth brings a wealth of knowledge and expertise to Meharry along with a great appreciation for our college’s legacy.”

For Hildreth, the decision to return, following his post as dean of the University

of California Davis’ College of Biological Sciences, wasn’t difficult. “What drew me back is the opportunity to play an important role in an institution whose mission resonates with me personally,” he said. “I want this to be my last job.”

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The Road Back to Meharry Meharry’s mission to serve the underserved resonates strongly with Hildreth. “I just believe no matter who you are, you deserve the best care,” he stated. “Excellence and caring for people who are disadvantaged are not mutually exclusive.”

That foundational belief was born of personal experience. Growing up the youngest of seven children in rural Arkansas, Hildreth watched his father succumb to cancer. “My father died when I was 11 years old. I didn’t understand why he didn’t get more medical care,” Hildreth recalled. “When I was 13 years old, I decided I would do something about my concern over how healthcare was delivered.”

A bright, engaged student who always loved science, Hildreth credits a high school teacher with sparking his love of biology. After graduation, Hildreth headed to Harvard where he received his degree in chemistry in 1979.

The first African-American Rhodes Scholar from Arkansas, Hildreth left for what was supposed to be two years at Oxford. “I understood the power of education, but to have all those people come to one place … one old, old place … and be surrounded by amazing scholars was a pretty powerful thing to me,” he recalled of the exciting juxtaposition of new ideas flowing through hallowed halls where students have learned for nearly 1,000 years.

By the time he arrived in England, Hildreth knew where his interest was leading him, and he was eager to study under several renowned immunologists at Oxford. “I petitioned, and petitioned and petitioned until the warden gave me two more years of support so I completed my PhD at Oxford,” he said. Persistence, he laughed, paid off, and he received his doctorate in immunology in 1982.

From there, he returned stateside and enrolled in Johns Hopkins School of Medicine. Taking a year off in the middle of his training for a postdoctoral fellowship, Hildreth graduated in 1987. “The same year I finished medical school, Johns Hopkins offered me a faculty position, and I remained on faculty until I came to Meharry in 2005,” he said.

Hildreth’s first stint at Meharry was as a professor from 2005-2011. In addition

to founding Meharry’s Center for HIV/ AIDS Health Disparities Research, the internationally renowned physician-scientist received a National Institutes of Health grant to establish Meharry’s Translational Research Center. He also served as associate director of the Vanderbilt-Meharry Center for AIDS Research.

His groundbreaking work led to the discovery that HIV needs cholesterol to fuse with a host cell and has opened up new avenues of attacking the virus’ Achilles’ heel, including the development of microbicides to try to thwart transmission.

During his time at U.C. Davis, Hildreth introduced formal fundraising to the College of Biological Sciences and more than doubled the amount of private funds raised. He created a biology postdoctoral program, hired 16 new faculty members, and opened a first-of-its-kind advising center for undergraduate students.

Hildreth succeeds A. Cherrie Epps, PhD, the longtime member of Meharry’s leadership team who stepped in to fill the void in 2013 when former president and CEO Wayne Riley, MD, resigned his post. His return to Nashville fit well both professionally and personally. Hildreth is married to Phyllis, an attorney who teaches conflict resolution at Lipscomb University. The couple has two children – daughter Sophia is an attorney in the Judge Advocate General’s (JAG) Corps at Fort Bliss, Texas, and son Jay is a senior at the University of Oregon.

The Journey Forward Hildreth is clearly not content to rest on past accomplishments. “There is a need to rethink where we’ve trained students and how we are training them,” he said.

“Interprofessional education is really important,” he continued. “If outcomes are the metric we’re going to use to measure ourselves by, physicians have to be able to work as teams.” Hildreth added, “As a research scientist, in my world, collaboration has been the order of the day for some time now.”

He stressed the need to join forces with academic and community organizations to strengthen healthcare delivery.

“Part of my vision for Meharry as president is to continue the partnerships and collaborations we already have and expand on that.” Hildreth added another focus would be to implement innovative ideas. “Being a small, nimble institution, we can do some things larger institutions cannot.”

Calling himself ‘chief cheerleader’ for an incredible faculty and student body, Hildreth said, “I’m really excited to be back and look forward to great things to come. I think with the right focus, vision and plan, we’re going to do some amazing things here.” nashvillemedicalnews

.com

The doctors’ doctor:

Dr. Ming Wang Harvard & MIT (MD, magna cum laude); PhD (laser physics) Performed surgeries on over 4,000 doctors Dr. Ming Wang, Harvard & MIT (MD, magna cum laude); PhD (laser physics), is one of the few cataract and LASIK surgeons in the world today who holds a doctorate degree in laser physics. He has performed over 55,000 procedures, including on over 4,000 doctors (hence he has been referred to as “the doctors’ doctor”).

Dr. Wang currently is the only surgeon in the state who offers 3D LASIK (age 18+), 3D Forever Young Lens surgery (age 40+) and 3D laser cataract surgery (age 60+). He has published 7 textbooks, over 100 papers including one in the world-renowned journal “Nature”, holds several U.S. patents and performed the world’s first laser-assisted artificial cornea implantation. He has received an achievement award from the American Academy of Ophthalmology, and a Lifetime Achievement Award from the American Chinese Physician Association.

Dr. Wang founded a 501c(3) nonprofit charity, the Wang Foundation for Sight Restoration (www.Wangfoundation.com), which to date has helped patients from over 40 states in the U.S. and 55 countries worldwide, with all sight restoration surgeries performed free-of-charge.

Amniotic membrane is obtained after the baby’s birth

Inventions & Patents 1. LASERACT: All-laser cataract surgery U.S. patent filed.

2. Phacoplasty U.S. patent filed.

3. Amniotic membrane contact lens for photoablated corneal tissue U.S. Patent Serial No 5,932,205.

4. Amniotic membrane contact lens for injured corneal tissue U.S. Patent Serial No 6,143,315.

5. Adaptive infrared retinoscopic device for detecting ocular aberrations U.S. Utility Patent Application Serial No. 11/642,226.

6. Digital eye bank for virtual clinical trial U.S. Utility Patent Application Serial No. 11/585,522.

7. Pulsed electromagnetic field therapy for nonhealing corneal ulcer U.S.patent filed.

8. A whole-genome method of assaying in vivo DNA protein interaction and gene expression regulation U.S. patent filed

AMNIOTIC MEMBRANE CONTACT LENS

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Professional Development: Programming Hones Clinical, Business & Leadership Skills

By CINDY SANDERS

Education plays a key role in the daily operations of both the Tennessee Medical Association (TMA) and Tennessee Nurses Association (TNA) as the statewide organizations strive to ensure providers deliver efficient, effective care of the highest quality.

TMA & CME “We’ve got a lot going on with CME and have really ramped up over the last year,” said Dave Chaney, director of Communications for TMA. In fact, he noted, the organization recently completed a 20-month process through the Accreditation Council for Continuing Medical Dave Chaney Education (ACCME) to create original CME content.

TMA received provisional accreditation last November. At the end of two years, they will undergo another ACCME review to receive a four-year standard accreditation or six-year accreditation with commendation. This expanded capability is in addition to the organization’s long-

standing accreditation to approve other’s CME programming.

Angie Madden, director of Practice Solutions for TMA, explained, “We felt as a medical society that we needed to be more nimble and be able to provide education to physicians in Tennessee and particularly our members.” She added much of TMA’s content focuses on broad issues Angie Madden impacting all physicians but noted specialty-specific breakouts are featured at the annual meeting or in collaboration with other organizations as needed to meet physician needs.

Chaney said, “Physicians have a lot of sources out there where they can get CME. We want all physicians in Tennessee to look to TMA as the authoritative source for education on the most important and timely topics affecting their profession.” He added, “TMA is plugged in on every legislative and regulatory issue.

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a mix of online and in-person formats to deliver programming and featured more than 21 hours of onsite education at the April annual meeting. He added some programs, such as this summer’s ICD-10 Coding Camps, are presented in a roadshow format with a series of workshops being held at key points across the state.

Madden said the association is continually adding new offerings and is rolling out two new options this month. The first, Tennessee Health Care Innovations Initiative 101 is an overview of new payment models by the state. The second one-hour course, Tennessee Physician Employment Contracting, helps physicians know what to look for when crafting or signing contracts and is presented by TMA’s legal counsel.

For a complete list of options, go online to tnmed.org and click on Professional Development.

TNA & CNE The staff of the Tennessee Nurses Association is also passionate about ensuring providers are equipped to face the challenges of delivering quality care in an era of reform.

“We are accredited by the American Nurses Credentialing Center as an approver and provider of continuing nursing education,” explained TNA Executive Director Sharon Adkins, MSN RN, who added her organization is the only one in Tennessee that can apSharon prove CNE courses.

Adkins, MSN, She continued, RN “We’ve got a whole committee of reviewers, and they make sure the program meets the ANCC standards for quality of education and objectives and provides the learner with expected outcomes.”

Adkins said the association also collaborates with others to meet needs.

Working with the TMA, she noted, “We partnered with them last fall on a diabetes workshop and are currently partnering on the ICD-10 workshops being held across the state.”

In addition, the organization teams up with the Tennessee Association of Student Nurses to provide continuing education at the annual conference each fall. This year’s meeting – Nursing Ethics: Commitment, Compassion, Quality Care – will be held Oct. 23-25 at the Franklin Marriott Cool Springs. To register, go to tnaonline.org.

John Ingram Institute for Physician Leadership In addition to their new course offerings, the TMA recently rebranded the Physician Leadership College as the John Ingram Institute for Physician Leadership, honoring the East Tennessee internist and former president who helped create

and launch the program. In its new incarnation, physicians will now have two track options – the Leadership Immersion Weekend Retreat and the nine-month Physician Leadership Lab. Madden noted the first class graduated from the Physician Leadership College in 2008 with the eighth class graduating this past May at the 2015 annual meeting. While the core leadership topics of negotiation, decision-making, conflict resolution, collaboration and influence, medical advocacy, media and communications, resonated strongly with those who participated, Madden said the nine-month commitment made it difficult or impossible for some physicians to tap into the impactful curriculum.

“What we decided to do was create a weekend emersion where they would get all the training but in an accelerated, more convenient platform,” Madden explained.

To be eligible, an applicant must be a member of the TMA. Madden and Chaney noted the cost is kept low to make the program accessible. “We underwrite 90 percent of the costs through grants,” Madden added.

The next offering of the Leadership Immersion Weekend runs July 23-26 at the Hutton Hotel in Nashville. Those interested in attending or nominating someone to attend should go online to tnmed.org/ leadership for details and an application.

The new Physician Leadership Lab, which does span nine months, focuses on team-based care, safety and quality initiatives and includes LifeWings’ Lean plus TeamSTEPPS process improvement tools and programming. Madden pointed to changes tied to value-based reimbursement as an impetus to launch this new leadership offering.

“We wanted to create this new track to address the changing healthcare landscape,” said Madden, adding the goal is “to really help equip and train physicians with the skill set to practice medicine with all these new initiatives.”

Additionally, she noted the Physician Leadership Lab includes a hands-on project for participants. “They will pick a project in their community that they are passionate about and will work to impact outcomes, processes, and safety. They will take skills they have learned in TeamSTEPPS-Lean Healthcare and put them into practice.”

While details were still being fleshed out at press time, the plan is to launch in the fall and run through April with graduation at the 2016 annual meeting. Madden said the program would be a mix of live sessions, webinars and conference calls.

“With team models emerging, physicians need a different type of leadership skills they might not have needed in the past,” said Chaney. “Taking care of patients is number one, but any time you have physicians building skill sets, that’s going to benefit patients.” nashvillemedicalnews

.com

Lifelong Learning

Tapping into Vanderbilt’s Diverse Array of CME Opportunities

By CINDY SANDERS

Vanderbilt University Medical Center’s mission is to shape the future of health and healthcare. As an academic campus, education is a central component of moving that mission forward … not only through the innovative curriculum offered to students attending the prestigious medical school but also by providing a robust menu of continuing medical education (CME) offerings open to practitioners within and outside the Vanderbilt network.

“Vanderbilt is considered to be one of the top 10 research institutions in the U.S.,” said Don Moore, PhD, director of the Office for Continuous Professional Development.

“Along with that ranking, comes an obligation,” he continued. “We help practitioners gain access Dr. Don to the latest information Moore that they can take back to their practices. We have a communitybased mission in that respect.”

Moore, who is also a professor of Medical Education and Administration for Vanderbilt University School of Medicine, said CME programming focuses on four areas – clinical, teaching techniques, research and health systems administration

– with the majority of offerings being clinically focused.

“When you design a CME activity, you want to design it for effectiveness,” he noted. “To do that, you really need to know what the learning needs are.”

Moore said departments and divisions at VUMC help drive content by tapping into data, research and other information resources to address those needs and disseminate the latest advances in evidence-based medicine and underscore best practices, which is critical in an era where value, efficiency and quality are redefining how healthcare is delivered. “As the healthcare system is changing, we obviously need to help physicians understand how those changes will impact what they do,” Moore added.

While most courses are geared to physicians, Moore said anyone associated with a particular disease area is welcome to attend. Looking back at the past year, he estimated attendance was about 75 percent physicians and 25 percent other health professionals. “We have a large number of nurses who attend our courses,” he said.

“They can transfer our credit to their nursing requirements.”

Moore continued, “We recognize healthcare is delivered in teams. Our long term goal is to offer interprofessional education where doctors and nurses are not just sitting in the same room listening to physi-

cian content but where the content actually contains information for both of them, and they are working together.”

A key area for Office of Continuous Professional Development is maintenance of certification. In 1999, specialty societies began rolling out a new requirement for specialty certification in which physicians were required to conduct a quality improvement project that would impact their patients. However, Moore noted, that new requirement really began being broadly enforced in 2014.

“We now have the responsibility in our office to provide physicians with support for their quality improvement projects.

Our goal is to help physicians provide the best possible care to their patients. Our involvement in maintenance of certification is another way to do that,” he said.

Moore’s office posts information about upcoming programs online which physicians and other health professionals can access by going to cme.vanderbilt.edu.

Registration fees, where applicable, and details on location, target audience and course overview are available under the ‘CME Activities’ tab on the website.

Vanderbilt University School of Medicine is accredited with commendation by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Two Quick Questions for Dean Taylor Cathy Taylor, DrPH, MSN, RN, dean and professor for the Gordon E. Inman College of Health Sciences & Nursing at Belmont University, recently shared her thoughts on preparing the next generation of providers.

Q: With the number of health sciences degrees under Dr. Cathy Taylor the Belmont umbrella, has the university embraced interprofessional education?

A: “Yes … and in fact the diversity of our programs, coupled with our state-of-the-art simulation and practice laboratories, create rich opportunities for cross-disciplinary IPE at Belmont that are simply not available to students in most universities.

Q: How does this training translate into clinical practice after graduation?

A: “We continually monitor practice standards and survey employers to ensure that our graduates are equipped with the most current skills. At present, this translates into robust practice and residency experiences with area physicians and with our local med school partners at Meharry and Vanderbilt.

This is important to all of us. Strategic initiatives are underway to increase these traditional training opportunities and further supplement them with laboratory practice, particularly in high risk areas like obstetrics and pediatrics.”

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Wang Debuts 3D Laser KAMRA in Tennessee explained Wang. “You can actually see further and see Last month, Ming closer.” It’s the same concept Wang, MD, PhD, perfor the KAMRA inlay, he formed the state’s first 3D added.

Laser KAMRA procedure Before approving the to improve near vision in KAMRA inlay, the FDA recertain patients with presbyviewed results of three cliniopia. cal studies. At one year after The KAMRA inlay by implantation, 83.5 percent AcuFocus, which received of patients in the main study approval from the U.S. Food achieved uncorrected near vi& Drug Administration in sual acuity of 20/40 or better.

April, is the first implantable In addition to not being device for correction of near intended for use in patients vision in patients who have who have had cataract surnot had cataract surgery and Dr. Ming Wang prepares to insert Tennessee’s first KAMRA ring to improve near vision in a gery, other exclusion criteria don’t need corrective lenses patient with presbyopia. include severe dry eye, an for distance vision. active eye infection or inflamWang said about 25 percent of the popmation, insufficient corneal thickness, active opaque device, which is implanted in the ulation is nearsighted, 25 percent farsighted, autoimmune or connective tissue disease, cornea of one eye, blocks peripheral light and the remaining 50 percent don’t typically and uncontrolled glaucoma or diabetes, rays while allowing central light rays to pass need glasses … until they hit their 40s and among others. through a small opening in the center of the begin to experience presbyopia, a loss of the device to focus near vision. While the ability ability to change the focusing power of the Expanded Use to see small print is improved in the eye that eye that occurs naturally with age.

Currently, the KAMRA labeling warns has the implant, the distance vision of the “As they get to age 40-45, they need the safety and effectiveness in patients who two eyes working together isn’t affected so reading glasses,” Wang noted. “To them, have had LASIK or other refractive propatients get the best of both worlds. it’s a dramatic change of quality of life,” he cedures are unknown. While the 11 proce“When we implant a pinhole device, said of those who haven’t previously dealt dures Wang performed on June 9 met the such as the 3D Laser KAMRA, it focuses with eye problems. He added that up until original FDA criteria, he believes with phyentrance light into a narrow beam, which now, there hasn’t been an effective surgical sician discretion and additional research, greatly increases the depth of focus or range solution to treat presbyopia other than invathe use could be expanded. of vision for our patients,” Wang said. sive lens surgery.

LASIK, he noted, isn’t usually a pre“When you focus … when you shrink the For many, the KAMRA inlay might ferred option for patients after age 40-45. aperture … every cameraman knows when offer a new answer. The ring-shaped, While the original problem might be coryou do that, you increase the depth of field,” rected, patients of that age almost immediately begin to need reading glasses.

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going challenge to address presbyopia. “As a result, our baby boomer patients have been left on the sidelines of modern laser vision correction treatment.”

Wang said a monovision approach – where one eye is for distance and the other for near vision – is sometimes tried. “The problem with that is I’m intentionally moving the focal point of the non-dominate eye closer. You can read better, alright, but that eye will be blurry for distance,” he explained. Wang added the symmetry of both eyes is important for depth perception. “It works for some people, but it doesn’t work for others … they don’t like the asymmetry,” he added of monovision.

That, he continued, is potentially the beauty of being able to insert the KAMRA inlay in patients who have previously had LASIK. “You’re not introducing asymmetry between the two eyes. I simply add on top of what you have … I’m not taking anything away,” he said.

Wang concluded, “We’ve been looking for a solution to add to our capabilities. That’s the dream … how can you add reading capability in an eye with a lens that’s inflexible?”

Potentially, 3D Laser KAMRA could offer that solution to expand near vision beyond the current FDA approval for the millions who only need reading glasses to an even larger group of patients who have one of the three other ocular conditions plus presbyopia.

“We are excited to be the first again,” Wang said of debuting the new laser surgery option. “The focus of 21st century medicine now is to improve our sight even as we age to enable our patients to see better and longer. It improves the quality of life for our patients.”

Implementing Innovation, continued from page 1 “They had one preclinical year instead of the traditional two,” she said. “The clerkship year got moved to the second year from the third.” The first phase, Foundations of Medical Knowledge, integrates biomedical, behavioral, social and systems sciences, medical humanities, and physical diagnosis. The core clerkship phase, Foundations of Clinical Care, consists of six clerkships over a 41-week period and includes an emphasis on cost effective diagnostic approaches.

Miller continued, “What that does is give us more time in the third and fourth years to do a couple of things … the first is to allow (students) to delve more deeply into areas they are most interested in so they have two elective years instead of one.”

In addition, she said, “We already have started to implement a new content area, which is really taking a systems approach to care.”

Students look at healthcare from the macro level – with a focus on population health, healthcare economics, the Affordable Care Act and other policy impacting care delivery – down to the micro level of how to manage patients and populations within the practice setting with a lot of

thought given to transitions of care.

Additionally, research projects have been given more emphasis. Where students previously embarked on an eightweek project, all are now required to complete at least a three-month research project, with some students undertaking a six-month project.

While advanced clinical competencies are still central to a Vanderbilt medical education, Miller said the focus has broadened to the delivery of collaborative, high quality, highly efficient care.

“Especially for our students, who we hope will be leaders, it’s very, very important for them to have an idea of how the system works,” Miller said.

Equally important is for the students to understand how they, themselves, learn and progress. Portfolio coaches keep up with scores, tests, clinical evaluation forms, and other measures to graphically show a student’s growth over time. Miller said these coaches help students individually identify strengths, weaknesses and the best ways to learn.

“We hope this is something they’ll carry with them … being reflective practitioners, self aware, and always striving for improvement,” Miller concluded. nashvillemedicalnews

.com

Genetic Counseling Crucial as Personalized Medicine Evolves

By MELANIE KILGORE-HILL

As personalized medicine reshapes healthcare, genetic counselors have become instrumental partners to providers.

Susan Caro, MSN, director of Family Cancer Risk Services for Saint Thomas Health, is a nurse practitioner credentialed as an advanced practice nurse in genetics, and provides cancer risk assessment and counsel about hereditary susceptibility to cancer and genetic testSusan Caro ing. Caro said cancer risk counseling has come a long way since taking family risk assessments in the early 1990s.

“The object then was to try and select women at high risk of breast cancer and watch them carefully,” said Caro.

After BRCA testing became available in 1994, Caro said patients were terrified of discrimination based on preexisting conditions. Fast-forward to 2015, and we’ve come a long way from pricey single gene tests to extensive panel tests for 20-40 genes.

“For the first decade it was, ‘Who do we test?’ and then, ‘What do we do with it?’” Caro said.

Milestones in Genetic Testing Universal acceptance of genetic testing has been a huge leap for the medical community in recent years. A 2013 Supreme Court ruling prohibiting the patent of BRCA1 and 2 testing marked a milestone that’s allowed for more affordable testing options.

Caro said the development of panel tests through next generation sequencing also have allowed for a massive reduction in testing costs. But despite their success, large panel tests aren’t without their limitations.

“One of most important things we tell patients is that this changes every day,” Caro said of panel testing. “The information we share today wasn’t even available five years ago so oftentimes we don’t have enough information to know if there’s been a mutation. The most important thing I share is that this will change with time. If we don’t answer questions now, we need to keep asking and revisit every year or two.”

That’s because many genetic variances are still of unknown significance, meaning providers lack the evidence to know if a genetic change affects the function of the gene. Caro also warns that the absence of a mutation might actually be a technological oversight, as new genes are added to the panels and technological advances improve detection of mutations.

Rules of Genetic Counseling As genetic testing becomes more nashvillemedicalnews

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prevalent, Caro said lab selection is critical.

“The choice of lab really makes a difference, as one lab a might go deeper into the intron, or another lab might have seen a genetic variation so often that they characterize it as nothing,” Caro said.

Add to that concern the growing availability of do-it-yourself genetic tests once available only through providers.

Recently, Silicon Valley-based Color Genomics launched their website offering saliva test kits for $249 – one-tenth the price of many tests now on the market.

Results include an analysis of BRCA1 and BRCA2, plus 17 other cancer-risk genes.

While controversial, the tests are becoming mainstream thanks in part to the Supreme Court’s 2013 BRCA ruling.

More choices for patients and providers means genetic counselors are working overtime to educate all audiences on the importance of counseling. Caro said physicians should strongly urge patients to first meet with a genetic counselor to avoid being blindsided, disappointed or surprised by results.

“Primary care providers are being marketed to directly by labs, saying that this is an appropriate test,” Caro said.

“That’s great as long as someone’s talking to the patients about it beforehand. It becomes a clinical and emotional emergency for counselors when someone in the community gets test results back without having had appropriate discussions in advance.”

Pre-testing conversations typically take two hours and include family history and high-level genetic education. Sometimes conversations result in a delay, while other patients opt to not test.

Which begs the question … Who should be tested? Experienced counselors like Caro, who have often caught the unexpected in panels, have a very low testing threshold.

“Sometimes we might find something that gives us the opportunity to prevent cancers in relatives,” she said. “We get excited about finding something because it helps us answer a question or make a difference for someone who’s at risk. More information means more choices, and a lot of patients are willing to take that risk.”

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Effective July 1, the Tennessee Department of Health’s Office of Vital Records is increasing fees charged for providing birth and death certificates. Going forward, each type of certificate will cost $15 per copy for both first and additional copies.

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Breaking Through: Personalized Medicine Innovation Abounds, continued from page 1 trials that we have available, especially as it relates to early-phase options.”

According to Bauer, Sarah Cannon enrolls more than 1,000 patients in earlyphase clinical trials annually and has conducted more than 170 first-in-man clinical trials to date, including several key trials focused on matching tailored treatments to patients’ tumor profiles. Bauer said personalized medicine is steering treatment away from the “therapy by cancer type” model of yesterday and toward treatment determined by each patient’s genetic mutation or alteration.

“Enrolling patients in clinical trials is important in determining how these mutations affect cancers,” he said. To that end, SCRI is offering genetic “basket type” studies in personalized medicine – including the Genentech MyPathway Program and the Novartis Signature Program across the Sarah Cannon Cancer Network – that are expected to last six months to one year.

“Today we are discussing with our patients how technology allows us to look at DNA in their tumor cells, which didn’t exist five years ago,” Bauer said. “The explosion of technology continues to pick up speed and provides us with valuable information to offer more personalized treatment options to our patients.”

Vanderbilt-Ingram Cancer Center Vanderbilt-Ingram Cancer Center Oncologist Jordan Berlin, MD, directs VICC’s Phase 1 clinical trials program and is co-leader of the GI Cancer program. He said personalized medicine also is changing the way patients are selected for trials.

“We used to take random patients and put Dr. Jordan them on Phase 1 trials …

Berlin but now with personalized medicine we can know, at the earliest point, those who theoretically have the best chance of response based on lab data,” Berlin said. “Since we have potential signals, we don’t just go to Phase 2 now but can expand the trial to allow a higher chance of response based on lab data. We do trials that target something specific about a person’s tumor that may give them a better chance of benefitting from treatment.”

Berlin said GI cancers have traditionally lagged in personalized medicine studies, but he believes the ability to identify protein inhibitors in certain cancers will result in more effective treatments. He’s already seen success in treating GI stromal tumors with targeted therapies and urges physicians to consult an oncologist before deeming a patient’s cancer untreatable.

“We’re getting there one piece at a

Online Bonus: NIH Director Francis Collins, MD, PhD, recently addressed the next steps in precision medicine with a Nashville audience. Go to NashvilleMedicalNews.com 8

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time,” Berlin said. “We may only find a targeted therapy that works for four to six percent of patients with a single cancer, but as we start adding groups, we start getting larger and larger numbers of patients doing much, much better.”

Personalized Medicine & Cardiac Care While oncology has long been a focus of personalized medicine, Vanderbilt’s Personalized Medicine department is looking beyond cancer to assess risk of other diseases.

Cardiologist Dan Roden, MD, assistant vice-chancellor for Personalized Medicine, regularly sees patients with genetic heart disease. Now, researchers in Vanderbilt’s Roden Laboratory are investigating mechanisms underlying variability in response to drug therapy, with a Dr. Dan particular focus on theraRoden pies used to treat cardiac arrhythmias. One set of studies is analyzing common genetic variances between those with and without AFib. “The biology we’re discovering is incredibly exciting and is in a place in the genome no one would ever think to look,” Roden said. One gene important in AFib, for example, controls early cardiac development. As the heart starts to develop, the gene in question turns off the pacemaker on the left side. That gene could lead to new biomarkers and clearer indications for use of common drugs like warfarin.

“The benefit is that eventually we’ll get to a point where we’ll have enough knowledge of genetic variance,” Roden said. “By understanding disease, we’ll be a in a much better place to develop new therapies.”

In fact, fall 2015 will usher in a new class of drugs for the treatment of high cholesterol – a drug class resulting directly from the Human Genome Project. PCSK9 inhibitors prevent the protein PCSK9 from interfering with the liver LDL removal process, allowing more LDL cholesterol removal from the blood.

“PCSK9 inhibitors are the fruits of a genetic revolution, and we’re just starting to see it,” Roden said.

DiaTech Oncology An increasingly visible player in the personalized medicine field is CorrectChemo by DiaTech Oncology. Since launching commercial operations in 2014, the Franklin-based company has run several thousand tests matching patients’ tumor samples with the best possible chemotherapy options, delivering results within 72 hours.

“Research is validating that a ‘one size fits all’ approach to cancer treatment is no longer valid,” said DiaTech Marketing Director and healthcare veteran Amanda Cecconi.

DiaTech’s novel approach is gaining acceptance by the medical community and research continues with The Mayo Clinic and other prestigious institutions. The

personalized model also offers potential efficiencies to at-risk organizations wading through the transition to value-based care.

“Value-based care is driving the industry to find Amanda new ways to better manCecconi age the cost of cancer,” Cecconi said. “Chemo is usually the No. 1 expense in cancer treatment delivery. Patients don’t want more chemo, they want chemo that works for them.”

InSight Genetics Another game changer in Nashville’s personalized medicine industry is Insight Genetics, a molecular diagnostics company working to further precision cancer care at times of diagnosis, treatment and therapeutic resistance. A key focus for the company is triple negative breast cancer, which CEO

Eric Dahlhauser calls the last frontier in breast cancer.

“Triple negative breast cancer has a very bad prognosis and is a class that’s often defined by what you are not,” Dahlhauser said, noting the many subtypes of cancer possible within a single diagnosis.

“There’s a great unmet Eric need here as no targeted Dalhauser therapies exist.”

Formed in 2007, Insight Genetics also focuses on ALK mutations, common in lung and other cancers. “Providers are now driving therapy decisions based on mutations, which is also true for assays in triple negative breast cancer,” he said. “We’re moving away from organ indication and toward an era of understanding the genetic driver behind a cancer and knowing which drugs should work best for each patient.”

ASCO Conference Showcases Latest in Oncology Treatment

By MELANIE KILGORE-HILL

On May 29, Nashville oncologists and researchers headed to Chicago for the annual American Society of Clinical Oncology conference. Among those in attendance was Todd Bauer, MD, associate director of Drug Development and principal investigator at Sarah Dr. Todd Cannon Research InBauer stitute. Bauer said there were very clear take-home messages from the meeting.

“Immuno-oncology, or using medicine that enhances the system’s ability to control cancer, is going to continue to be a very exciting area in oncology,” Bauer said. “It’s very well tolerated and shows a significant benefit for long lasting responses.”

Targeted therapies, which consider specific mutations and genetics, also played an important role in the meeting. “We’re trying to better match therapies to patients based on specific tumor DNA,” he said.

NCI-MATCH Program Another focal point was the NIH’s NCI-Molecular Analysis for Therapy Choice (NCI-MATCH), a clinical trial that will analyze patients’ tumors to determine whether they contain genetic abnormalities for which a targeted drug exists (“actionable mutations”) and assign treatment based on the abnormality.

NCI-MATCH seeks to determine whether treating cancers according to their molecular abnormalities will show

evidence of effectiveness. NCI-MATCH could add or drop treatments over time, and each treatment will be used in a unique arm of the trial.

The trial opens for enrollment this month with 10 arms. Each arm will enroll adults 18 years of age and older with advanced solid tumors and lymphomas that are no longer responding (or never responded) to standard therapy and have begun to grow.

SMART Precision Cancer Medicine The meeting also served as an outlet for Vanderbilt University Medical Center to present a mobile computer application under development called SMART Precision Cancer Medicine (PCM), featured in a demonstration of improved cancer care coordination through clinical data interoperability and electronic clinical information sharing.

SMART (Substitutable Medical Apps and Reusable Technology) is a computing platform designed to allow apps to work with all manner of medical record systems.

SMART PCM runs on smartphones and tablet computers and is intended one day to help cancer patients and their doctors understand and act on genetic test results.

It communicates with medical records systems using a new interoperability language called FHIR (Fast Healthcare Interoperability Resources).

The demonstration highlighted the advantages of data interoperability by following a hypothetical colon cancer patient through risk assessment in the clinic, genomic testing, surgery, chemotherapy administration and home care. nashvillemedicalnews

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HealthcareEnterprise

MDsave’s E-commerce Model Takes Healthcare in a New Direction his orthopaedist with a knee problem and learns an MRI will cost $2,500 outof-pocket so he doesn’t get it, Ketchel explained. Not only does the hospital lose the MRI, the patient doesn’t get diagnosed. “We’re helping patients get an early level of care leading to faster surgical treatment,” he said.

On average, patients save 40-60 percent and providers generally net 10-15 percent more than with traditional reimbursement. Prepaid services mean patients have no bad debt, offices see zero claims processing, and providers are paid in six days or less. “What’s happening is that we’re wringing 30-40 percent of waste out of the system because of increased efficiency,” Ketchel said.

By MELANIE KILGORE-HILL

In the quickly evolving world of value-based healthcare, one company is taking cost transparency to the next level.

Meet MDsave, a web-based company offering self-pay patients and those with high deductible insurance plans an online resource to compare and save on healthcare-related expenses.

It’s the brainchild of Clyde Spencer and Paul Ketchel, industry veteran and former healthcare lobbyist. “I read one of the first Affordable Care Act drafts and saw the additional pay requirements and knew it would cause premiums to increase to cover costs,” Ketchel said of the company’s inception. “As premiums increased, we believed a majority of employers would move to a high deductible health plan option, and that for the first time Americans would become concerned with costs as they’d have to pay a substantial amount out-of-pocket before benefits kicked in.”

Ketchel then approached former U.S. Senate Majority Leader Bill Frist, MD, with the idea to utilize e-commerce to bundle otherwise pricey services. Today, MDsave includes a patented process that bundles services, segments payments and offer consumers one easy-to-understand price – all with a 100 percent money back guarantee.

How MDsave Works In a nutshell, healthcare providers post medical services with the total price they charge directly on the website. Patients enter the name of the procedure and their zip code and can then easily search, compare and purchase those services with

complete privacy. After a purchase is made, the customer is provided a medical voucher for the service, and the physician’s appointment desk is notified. Today, the website offers nearly 7,000 services in 100 markets across 22 states. Headquartered in Brentwood, MDsave also operates a San Francisco office for its engineering and web development team.

Benefit to Providers “Physicians reap the biggest benefit because a lot of patients can’t afford service, and they want to help their patients,” said Ketchel, who serves as the company’s CEO. “Now they can give patients a rate they can afford and a better one than they can find on their own.”

Case in point: A patient walks in to

Shopping Around Typically, MDsave sales are over $500 each and include services ranging from a few hundred dollars to those topping $20-30,000 like bariatric surgery. GI scopes, orthopaedic implants, advanced imaging and even cardiac cath procedures are all available with additional services and markets being regularly added.

“The healthcare community underestimated the ability of the patient to shop around,” Ketchel said. “That may have been true three or four years ago, but today when they (patients) call us, they’re extremely educated. They’ve already seen a doctor; they know exactly what they need; and they’re looking to find the best rate.”

Ketchel said many consumers purchase from providers they would have gone to anyway. “A service could be $5,000 here or $15,000 somewhere else

so we’re giving them access to care with plans they just don’t have,” he said.

In fact, more than 70 percent of MDsave patients have insurance and still file, making their deductible dollars go further.

Ketchel said insurance companies also like the model as it helps patients get the care they need sooner, preventing more complicated diagnoses and pricy ER visits down the line. Patient satisfaction is near 100 percent, and two-thirds of patients are referred to the site by their doctors.

For providers, the cost to participate depends on the size of the hospital or ambulatory center and can range from $5,000 to $12,000 per month. “Many hospitals have never had to think of patients this way before,” Ketchel said of the competitive, retail-driven model. “We help them know what to charge in their market and create bundles, while our Internet team in San Francisco says, ‘here’s what consumers are looking for and how to attract them.’”

Gaining Support In May 2015, MDsave announced its first institutional investment of $12 million from New York-based MTS Health Investors. The board, which includes Sen. Bill Frist and [recently added] MTS partner Oliver Moses, raised a total of $14.1 million in this round of financing.

“It’s truly a win/win for patients and providers,” Moses said in a companyissued release. “The MDsave team’s extensive healthcare knowledge and Silicon Valley technology innovation gives providers a platform to drive down costs, increase patient volume and pass savings on to patients.”

Joining Forces post King v. Burwell On June 29, U.S. Rep. Jim Cooper (D-TN), Saint Thomas Health President & COO Karen Springer, Nashville Mayor Karl Dean, and a bipartisan group of elected officials, business leaders and activists joined a roundtable discussion on the future of healthcare in Tennessee.

The group called for a renewed push to pass Insure Tennessee, Gov. Bill Haslam’s plan to expand insurance coverage that has twice met defeat in the State Legislature.

“Insure Tennessee makes sense for our economy and even more sense for our people,” Mayor Dean said. “Our uninsured citizens need it; our economy needs it; and our sense of humanity demands it.”

Springer added, “It is our mission to care for the widow, the orphan, the forgotten, and the neglected. To that end, it is imperative that we continue to fight for this cause.”

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THE STRENGTH TO HEAL and rediscover my passion for medicine.

The new experience you’ll gain as a member of the Army Reserve will help you remember why you became a physician. By practicing in your community and serving when needed, you could receive $250,000 in student loan repayment and $75,000 in Special Pay. You’ll feel an increased sense of pride when you care for our Soldiers and their Families.

To learn more about the U.S. Army Reserve health care team, visit healthcare.goarmy.com/mednews or call 615-874-5002.

©2010. Paid for by the United States Army. All rights reserved.

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GrandRounds Bacon Joins CapStar Industry vet Buddy Bacon has joined CapStar as senior vice president of the bank’s healthcare group.

He will team with CapStar EVP Mark Mattson to build the company’s industry presence after two of the bank’s healthcare leaders defected to the competiBuddy Bacon tion earlier this year.

Bacon was most recently CEO of MediTract. Before that, he led Meridian Surgical Partners, Xtensia and MedifaxEDI. Bacon began his career as a certified public accountant with LBMC.

Carter Joins KraftCPAs Longtime healthcare accountant Lucy R. Carter, CPA, has joined KraftCPAs PLLC as a member, effective July 1. The former co-founder of Carter Lankford CPAs made the move as partner Sara Lankford, CPA, announced her retirement at the end of June.

Carter will practice Lucy R. Carter in Kraft’s entrepreneurial services group and as a member of the firm’s healthcare industry team. All of the Carter Lankford employees will join KraftCPAs, bringing the firm’s total number of employees to approximately 180.

According to Vic Alexander, chief manager of KraftCPAs, “We have known Lucy and Sara for years and admired their firm. Their experience and reputation, particularly in the healthcare niche, are outstanding, and we’re fortunate to have Lucy and her team join our firm. We anticipate a lot of synergy between them and our affiliate Kraft Healthcare Consulting.”

Let’s Give Them Something to Talk About!

Awards, Honors, Achievements Four alert health professionals each recently recognized something was wrong when screening four different mothers in the Baby and Me Tobacco Free program. In each situation,

the women had troublesome levels of carbon monoxide in their systems that were noticed during a breathing evaluation. Home inspections were conducted, in which heating system gas leaks were identified and repaired, and the four mothers and their families were protected from harm. All four professionals have been presented the Tennessee Department of Health’s Commissioner’s Achievement Award. The recipients include Kelly Hooks, RN, Putnam County Health Department; Andrea Sansone, The Edge Women’s Care Center, Dayton; Kelly Soliman, RD, Cheatham County Health Department; and Katie Winterburn, MS, RDN, LDN, Lawrence County Health Department.

Ted Anderson, MD, PhD, professor of Obstetrics and Gynecology at Vanderbilt University Medical Center, has been elected treasurer of the American College of Obstetricians and GyneDr. Ted Anderson cologists (ACOG).

Murfreesboro dentist William R. “Roy” Thompson, DDS, MAGD recently received the Jack Wells Memorial Dedication to Dentistry Award during the Tennessee Dental Association’s 148th annual session in Nashville. The award, which isn’t presented every year, is given to truly deDr. Roy serving recipients who emThompson body four criteria set forth by the TDA: quality of practice, service to organized dentistry, contribution to dental education, and humanitarian service.

Lovell Communications recently accepted 10 Healthcare Advertising Awards from the Healthcare Marketing Report. The Nashville agency received highest honors in the social media category with Gold Awards for innovative campaigns on both Facebook and Pinterest. Lovell also received Bronze Awards in the newspaper advertising and calendar categories, along with Merit Awards in the brochure, newspaper advertising, outdoor transit/billboard, and logo/let-

Drummonds Takes the Helm at LBMC Jeff Drummonds has been named managing partner of LBMC. He succeeds Mike Cain and David Morgan, two of the founders and longtime co-managing partners of Lattimore, Black, Morgan & Cain.

Drummonds, who has been with the large regional accounting and business consulting firm for 14 years, most recently led the firm’s tax services group and has nearly 30 years experience.

Launched in 1984, LBMC now has nearly 450 employees and is one of Accounting Today’s “Top 50 Firms” in the nation with $74 (L-R): David Morgan, Jeff Drummonds & Mike Cain. million in revenue for 2014. In addition to accounting services, the LBMC Family of Companies includes and array of consulting expertise including marketing, technology, security, staffing, and investment advisory. Cain and Morgan will stay involved in the firm to lend “strategic oversight.”

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terhead categories.

Virginia Governor Terry McAuliffe has appointed David L. Miller, president and chief operating officer of Community Health Systems, Inc., to the Board of Visitors of the Virginia Military Institute in Lexington, Virginia.

The American AdverDavid L. Miller tising Federation Nashville recognized BlueCross BlueShield of Tennessee as the Multicultural Advertiser of the Year for its extensive efforts to support diversity and inclusion through its campaign to Hispanic audiences.

Arthur Dalley, PhD, professor of Cell and Developmental Biology at Vanderbilt, recently received the highest award for human anatomy education in the anatomical sciences during the 2015 Experimental Biology meeting in Boston. He acDr. Arthur cepted the Henry Gray/ Dalley Elsevier Distinguished Educator Award Medal for 2015 and was also named a Fellow of the American Association of Anatomists.

Based on a review of Medicare STARS 2014 quality data, Dickson Medical Associates has been recognized and rewarded by BlueCross BlueShield of Tennessee’s Medicare Advantage Quality Incentive Program as being among an elite group of top physician practices statewide serving plan members with outstanding supportive treatment and appropriate preventive care.

Amber Sims, vice president of Saint Thomas Health Alliance, was honored in Washington, D.C. on June 6 as one of “ToAmber Sims morrow’s Leaders” at the 2015 Catholic Health Assembly.

PUBLISHED BY: SouthComm, Inc. GROUP PUBLISHER Dennis Triola dtriola@southcomm.com 310.422.6637 SALES 615.844.9237 Jamie McPherson Maggie Bond, Heather Cantrell, Michael Jezewski, Mike Smith LOCAL EDITOR Cindy Sanders editor@nashvillemedicalnews.com NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com GRAPHIC DESIGNERS Katy Barrett-Alley, Amy Gomoljak, James Osborne, Christie Passarello CONTRIBUTING WRITERS Melanie Kilgore-Hill, Julie Parker, Kelly Price, Cindy Sanders CIRCULATION subscriptions@southcomm.com —— All editorial submissions and press releases should be emailed to: editor@nashvillemedicalnews.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 • Two years $78

Monroe Carell Named Among Nation’s Best The Monroe Carell Jr. Children’s Hospital at Vanderbilt has again been named among the nation’s leaders in pediatric healthcare in U.S. News & World Report’s annual “Best Children’s Hospital” rankings released June 9. The hospital achieved national rankings for a maximum of 10 out of 10 pediatric specialty programs, with half of those specialties among the top 20 in the country, including the hospital’s urology program, which maintained its rank in the No. 6 spot.

Five other pediatric specialties moved up in the rankings. Neurology & Neurosurgery improved from No. 42 to No. 15; Neonatology jumped from No. 45 to No. 27; Gastroenterology & GI Surgery moved from No. 40 to No. 32; and Diabetes & Endocrinology rose from No. 31 to No. 25. Other specialties ranked this year: Orthopaedics (12), Cancer (30), Cardiology & Heart Surgery (20), and Nephrology (42).

SOUTHCOMM Chief Executive Officer Paul Bonaiuto President Chris Ferrell Chief Financial Officer Ed Tearman Executive Vice President Of Digital And Support Services Blair Johnson Director Of Financial Planning And Analysis Carla Simon Vice President Of Human Resources Ed Wood Vice President of Content Patrick Rains Vice President Of Production Operations Curt Pordes Group Publisher Eric Norwood Chief Revenue Officer Dave Carter Director Of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Nashville Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2015 Medical News Communications.All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials.

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GrandRounds Certifications & Accreditations

Vanderbilt University Medical Center, in conjunction with VanderbiltIngram Cancer Center, has been reaccredited by the CEO Roundtable on Cancer as a CEO Cancer Gold Standard employer for 2015 in recognition of outstanding employee health initiatives to address and discourage tobacco use, promote physical activity, provide options for a healthy diet, detect cancer at an early stage and offer access to quality care.

The Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) Board of Trustees approved the accreditation of the University of Tennessee Health Science Center (UTHSC) as a separate university, UTHSC Chancellor Steve J. Schwab announced last month. Several years ago, in examining the governance structure, resources available, annual budget, geographic location, and relative autonomy from UT-Knoxville, SACSCOC leadership determined UTHSC should be a separately accredited institution within the UT System. “We remain an integral component of the UT System of universities overseen by President DiPietro and governed by the Board of Trustees of the University of Tennessee,” Chancellor Schwab noted.

symplr Acquires CBR Associates symplr™, a leading provider of SaaS healthcare compliance and credentialing solutions recently announced the acquisition of CBR Associates Inc. of Durham, NC. This marks the company’s third acquisition in less than two years.

Patrick Birmingham, vice president and general manager of Provider Management at symplr, which is headquartered in Houston and also maintains corporate offices in Franklin, Tenn. following an earlier merger with Medkinetics and Payor Enrollment Services, said, “By bringing CBR Associates into our fold, we’re able to offer an expanded solution to our combined customer base. CBR solutions have a 34-year track record of success at hundreds of healthcare facilities across the nation, and we’re very pleased to have such a talented team join us.”

Hanto Named Director of Vanderbilt Transplant Center

Douglas Hanto, MD, PhD, has been named director of the Vanderbilt Transplant Center effective July 1 when he succeeds Seth Karp, MD. Hanto is only the center’s fourth director since its founding in 1989.

Hanto joined VUMC in 2014 as the center’s associate director and has

worked with the departments of pediatrics and surgery to establish a pediatric liver center at Monroe Carell Jr. Children’s Hospital. In his new role, he will oversee administrative and clinical aspects of adult and pediatric kidney, liver, heart, lung and pancreas transplantation.

Previously, he was professor of Surgery and associate dean for CME at Washington University School of Medicine in St. Louis, where he also helped start a liver transplant program. He has also served as chief of the Division of Transplantation at Beth Israel Deaconess Medical Center in Boston and as a professor of Surgery at Harvard Medical School.

Vanderbilt Announces New Leadership For Adult Hospital, Population Health Vanderbilt University Hospital has promoted Mitchell Edgeworth to CEO of Vanderbilt University Adult Hospital and Clinics.

Edgeworth was previously COO for the Vanderbilt University Hospital and Clinics. He will succeed David Posch, who as served as CEO of the adult hosMitchell pital and clinics since 2011.

Edgeworth Posch has been named to the newly created position of associate vice chancellor for Population Health.

Edgeworth joined VUMC in 2012 as COO of Vanderbilt University Hospital. In his new role, he will focus on all aspects of operational performance and will work closely with the system’s clinical department chairs and operational leaders.

Edgeworth and Posch’s roles are effective immediately. Posch, who joined VUMC in 1999 as COO of the Vanderbilt Medical Group, will be responsible for ensuring the strategic direction of population health for VUMC and VHAN.

NuScriptRX Adds Chief Pharmacy Officer Nashville-based NuScriptRX™ recently announced the addition of Jimmy L. Tucker as chief pharmacy officer, a new role for the company. Tucker has more than 20 years experience in long-term care pharmacy management. In his new role, he is responsible for Jimmy Tucker all of pharmacy operations, long-term care client implementation, professional and regulatory affairs, and strategic business development.

Previously, Tucker served as president of Pharmacy for Vanguard Healthcare. He is a graduate of the University of Louisiana at Monroe College of Pharmacy.

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Promising Immunotherapy For Cancer Patients TENNESSEE ONCOLOGY’S William Donnellan, M.D.

Our immune systems are able to recognize cancer cells in several different ways. By the primary mechanism, tumor cells display proteins on their surface that are not displayed on normal cells. These proteins are called tumor-specific antigens, and they mark tumor cells as diseased or abnormal. This allows our immune system to recognize and kill them. However, tumor cells eventually develop ways to evade and suppress the immune system. This ultimately leads to progression of the cancer and resistance to treatment.

Efforts have therefore been made to prevent the suppressive effect that cancer has on the immune system. Recently, a class of medications called the “checkpoint inhibitors” has been developed.

These medications work by blocking the signals that cancer cells use to turn off the immune system. Presently, several checkpoint inhibitors are FDA approved for melanoma and lung cancer.

Checkpoint inhibitors are also showing promise in ovarian cancer, bladder cancer and Hodgkin’s Lymphoma.

The field of cancer immunotherapy is exciting and rapidly evolving.

All immunotherapies that are currently FDA approved are available through Tennessee Oncology. Additionally, by way of the partnership between Tennessee Oncology and Sarah Cannon Research Institute, many of the immunotherapies under development are available through clinical trials.

WILLIAM DONNELLAN, M.D. MORE THAN 80 PHYSICIANS IN 30 LOCATIONS

1.877.TENNONC | www.tnoncology.com